Ashley Fernandez
Southwest Ranches,FL
Summary
Forward-thinking Senior operations executive dedicated to continuous business improvement focused on enhancing revenue and streamlining business operations. Diligent in driving profit maximization through multifaced business approaches.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Vice President of Operations
Univida Medical Centers
08.2022 - 09.2023
- Oversee and manage current center staff while achieving revenue growth consistent with patient population
- Implement software systems to improve the company operations with internal software team
- Provided company developers all programming ideas and guidelines to build current Univida Data Analytics known as “UDA” including but not limited to: Member Engagement bonus, New Patient Enrollment Dashboard, High-Risk Patient Stratification, Real-Time KPI Dashboard
- Successfully oversaw the implementation of new EMR system, transition from AdvancedMD to eCW
- Assist Board Members with current development plans for future company growth
- Participate in building plans and visit existing construction with developers to provide guidance and establish the proper build for the correct “medical center flow”
- Manage the existing payor relationships with active plans
- Assisted Univida in negotiating terms with the existing plans and obtain new health plan contracts
- Univida payor matrix grew from 4 health plans to 10
- Referral utilization and management
- Manage the current referral staff and implement a specialist provider network
- Integrate franchises into existing company procedures and protocols
- Overview medical records processes and ensure compliance with record re-capture.
- Reduced operational risks while organizing data to forecast performance trends.
- Implemented business strategies, increasing revenue, and effectively targeting new markets.
- Negotiated price and service with customers and vendors to decrease expenses and increase profit.
- Hired and managed employees to maximize productivity while training staff on best practices and protocols.
- Managed cross-functional teams to ensure seamless collaboration for optimal business outcomes.
Senior Director of Coding, Credentialing and Shared Services
Cano Health
04.2017 - 06.2022
- Coding: Oversee and manage the coding team that renders nationwide services from a centralized department
- Medicare Advantage: -Management of coding services for over 300,000 members across 7 different states
- Provider Documentation Improvement efforts with the implementation of a Clinical Documentation Improvement “CDI” Department
- Responsible for providing t Chief Clinical Officer with KPI metrics for more than 200 providers and querying providers on best documentation practices.
- Fee-For-Service: -Responsible for the monthly collection of about 2mill including but not limited to: Aging Reports, Revenue Outliers, Financial/Banking Reconciliations, Financial integration of newly acquired practices
- Additionally, managed coding services for ACA, DCE, Medicaid, and Pediatrics
- Credentialing: Manage the organization’s credentialing services
- Designed and implemented a credentialing program that allows the entire organization to have real-time updates
- Responsible for the accreditation of all newly hired physicians with Medicare and Medicaid
- Additionally, accredited the providers into the Medicare Advantage and Fee-For-Service plans
- Credential and maintain the organization’s multi-state credentialing active across all plans
- Proficient in PECOS, NPI, I&A, CAQH, and Availity
- Shared Services: -Responsible for the Medical Records Department and the retrieval of all records
- Implemented processes that encompass pre-visit planning to ensure that providers have all required records prior to the patient visit
- Partnering with AI company to minimize the medical records department manual labor and departmental cost/growth
- Developed a Power-BI software for the referral department with a real-time dashboard of utilization costs and real-time management of the total referral volume per provider and specialty
- Team Development: -Managing a successful team of over 400 associates while developing an organization structure for each department including but not limited to: job description, KPI, and merit development.
- Assisted in organizing and overseeing assignments to drive operational excellence.
- Navigated complex regulatory environments to ensure compliance with local laws, standards, and regulations relevant to the business domain.
- Evaluated employee performance and conveyed constructive feedback to improve skills.
- Worked closely with organizational leadership and board of directors to guide operational strategy.
- Drove revenue growth through successful market expansion strategies, identifying untapped markets and capitalizing on emerging trends.
Office Manager
Complete Medical Billing Services
01.2006 - 03.2017
- Manage 20 medical coding and billing accounts including but not limited to: Medicare Advantage, Fee-for-Service, and ACA
- Financial reconciliation of all submitted claims
- Denial Management under a 5% and aging collections over >120 days under 3%
- Responsible for 25 associates, all staff certified coders prior to employment
- Gross Monthly Collection of >$500,000 with all accounts combined.
- Established workflow processes, monitored daily productivity, and implemented modifications to improve overall performance of personnel.
- Developed comprehensive policy manuals outlining procedures and guidelines, contributing to a well-organized workplace culture.
- Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
Education
Bachelor of Science -
Florida International University
Miami, FL06.2017
Skills
- Revenue Growth
- Performance Improvements
- Business Administration
- KPI Tracking
- Team Leadership
- Performance Evaluation and Monitoring
Certification
- CPC - Certified Professional Coder
- CRC - Certified Risk Adjustment Coder
Languages
English
Full Professional
Spanish
Full Professional
Timeline
Vice President of Operations
Univida Medical Centers
08.2022 - 09.2023
Senior Director of Coding, Credentialing and Shared Services
Cano Health
04.2017 - 06.2022
Office Manager
Complete Medical Billing Services
01.2006 - 03.2017
Bachelor of Science -
Florida International University
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